美国国家公共电台 NPR--Supreme Court looks at whether Medicare and Medicaid were overbilled under fraud law

Supreme¹ Court looks at whether Medicare and Medicaid were overbilled under fraud law

Transcript²

The U.S. Supreme Court will hear arguments on Tuesday in a case that could undermine one of the government's most powerful tools for fighting fraud in government contracts and programs.

The False Claims Act dates back to the Civil War, when it was enacted³ to combat rampant⁴ fraud by private contractors⁶ who were overbilling or simply not delivering goods to the troops. But the law over time was weakened by congressional amendments⁷.

Then, in 1986, Congress toughened the law, and then toughened it again. The primary Senate sponsor was — and still is — Iowa Republican Charles Grassley.

"We wanted to anticipate and block every avenue that creative lawyers ... might use to allow a contractor⁵ to escape liability for overcharging," Grassley said in an interview with NPR.

He is alarmed by the case before the Supreme Court this week. At issue is whether hundreds of major retail⁸ pharmacies⁹ across the country knowingly overcharged Medicaid and Medicare by overstating what their usual and customary prices were. If they did, they would be liable for triple damages.

What the pharmacies charged

The case essentially¹⁰ began in 2006, when Walmart upended the retail pharmacy¹¹ world by offering large numbers of frequently used drugs at very cheap prices — $4 for a 30-day supply — with automatic refills. That left the rest of the retail pharmacy industry desperately¹² trying to figure out how to compete.

The pharmacies came up with various offers that matched Walmart's prices for cash customers, but they billed Medicaid and Medicare using far higher prices, not what are alleged¹³ to be their usual and customary prices.

Walmart did report its discounted cash prices as usual and customary, but other chains did not. Even as the discounted prices became the majority of their cash sales, other retail pharmacies continued to bill the government at the previous and far higher prices.

For example, between 2008 and 2012, Safeway charged just $10 for almost all of its cash sales for a 90-day supply of a top-selling drug to reduce cholesterol¹⁴. But it did not report $10 as its usual and customary price. Instead, Safeway told Medicare and Medicaid that its usual and customary price ranged from $81 to $109.

How the whistleblowers responded

Acting¹⁵ under the False Claims Act, two whistleblowers brought suit on behalf of the government alleging¹⁶ that SuperValu and Safeway bilked taxpayers¹⁷ of $200 million.

But the Seventh Circuit Court of Appeals ruled that the chains had not acted knowingly, even if they "might suspect, believe, or intend to file a false claim." And the appeals court further said that evidence about what the executives knew was "irrelevant¹⁸" as a matter of law.

The whistleblowers appealed to the Supreme Court, joined by the federal government, 33 states and Sen. Grassley.

"It's just contrary to what we intended," Grassley said. "That test just makes a hash of the law of fraud."

The statute¹⁹ is very specific, he observes. It says that a person or business knowingly defrauds²⁰ the government when it presents a false or fraudulent claim for payment. And it defines "knowingly" as: "actual knowledge," "deliberate ignorance" or "reckless disregard of the truth or falsity" of the claim.

"These are three distinct mental states," Grassley said, "and it can be any one of them."

The companies' defense²¹

SuperValu and Safeway would not allow their lawyers to be interviewed for this story, but in their briefs, they argue that a strict intent requirement is needed to hold businesses accountable under the statute. That is to ensure that companies have fair notice of what is and is not legal. The companies are backed by a variety of business interests, among them defense contractors represented by lawyer Beth Brinkmann in this case.

Brinkmann maintains the False Claims Act is a punitive²² law because it imposes harsh monetary²³ penalties for wrongful conduct without clear enough agency guidance. Ultimately, she argues, the question is not one of facts.

"If there's more than one reasonable interpretation²⁴ of the law," Brinkmann said, "you don't know it's false."

Tejinder Singh, representing the whistleblowers, scoffs²⁵ at that interpretation, calling it an after-the-fact justification²⁶ for breaking the law.

"It has nothing to do with what you believe at the time you acted," Singh said, "and has everything to do with what you make up afterwards."

A decision in the case is expected by summer.

1 supreme   

adj.极度的，最重要的；至高的，最高的

参考例句：

• It was the supreme moment in his life.那是他一生中最重要的时刻。
• He handed up the indictment to the supreme court.他把起诉书送交最高法院。

2 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

3 enacted   

制定（法律），通过（法案）( enact的过去式和过去分词 )

参考例句：

• legislation enacted by parliament 由议会通过的法律
• Outside in the little lobby another scene was begin enacted. 外面的小休息室里又是另一番景象。 来自英汉文学 - 嘉莉妹妹

4 rampant   

adj.(植物)蔓生的；狂暴的，无约束的

参考例句：

• Sickness was rampant in the area.该地区疾病蔓延。
• You cannot allow children to rampant through the museum.你不能任由小孩子在博物馆里乱跑。

5 contractor   

n.订约人，承包人，收缩肌

参考例句：

• The Tokyo contractor was asked to kick $ 6000 back as commission.那个东京的承包商被要求退还6000美元作为佣金。
• The style of house the contractor builds depends partly on the lay of the land.承包商所建房屋的式样，有几分要看地势而定。

6 contractors   

n.（建筑、监造中的）承包人( contractor的名词复数 )

参考例句：

• We got estimates from three different contractors before accepting the lowest. 我们得到3个承包商的报价后，接受了最低的报价。 来自《简明英汉词典》
• Contractors winning construction jobs had to kick back 2 per cent of the contract price to the mafia. 赢得建筑工作的承包商得抽出合同价格的百分之二的回扣给黑手党。 来自《简明英汉词典》

7 amendments   

（法律、文件的）改动( amendment的名词复数 )； 修正案； 修改； （美国宪法的）修正案

参考例句：

• The committee does not adequately consult others when drafting amendments. 委员会在起草修正案时没有充分征求他人的意见。
• Please propose amendments and addenda to the first draft of the document. 请对这个文件的初稿提出修改和补充意见。

8 retail   

v./n.零售；adv.以零售价格

参考例句：

• In this shop they retail tobacco and sweets.这家铺子零售香烟和糖果。
• These shoes retail at 10 yuan a pair.这些鞋子零卖10元一双。

9 pharmacies   

药店

参考例句：

• Still, 32 percent of the pharmacies filled the prescriptions. 但仍然有32%的药剂师配发了这两张药方。 来自互联网
• Chinese herbal pharmacies, and traditional massage therapists in the Vancouver telephone book. 中药店，和传统的按摩师在温哥华的电话簿里。 来自互联网

10 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

11 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

12 desperately   

adv.极度渴望地，绝望地，孤注一掷地

参考例句：

• He was desperately seeking a way to see her again.他正拼命想办法再见她一面。
• He longed desperately to be back at home.他非常渴望回家。

13 alleged   

a.被指控的，嫌疑的

参考例句：

• It was alleged that he had taken bribes while in office. 他被指称在任时收受贿赂。
• alleged irregularities in the election campaign 被指称竞选运动中的不正当行为

14 cholesterol   

n.（U）胆固醇

参考例句：

• There is cholesterol in the cell of body.人体细胞里有胆固醇。
• They are determining the serum-protein and cholesterol levels.他们正在测定血清蛋白和胆固醇的浓度。

15 acting   

n.演戏，行为，假装；adj.代理的，临时的，演出用的

参考例句：

• Ignore her,she's just acting.别理她，她只是假装的。
• During the seventies,her acting career was in eclipse.在七十年代，她的表演生涯黯然失色。

16 alleging   

断言，宣称，辩解( allege的现在分词 )

参考例句：

• His reputation was blemished by a newspaper article alleging he'd evaded his taxes. 由于报上一篇文章声称他曾逃税，他的名誉受到损害。
• This our Peeress declined as unnecessary, alleging that her cousin Thornhill's recommendation would be sufficient. 那位贵人不肯，还说不必，只要有她老表唐希尔保荐就够了。

17 taxpayers   

纳税人，纳税的机构( taxpayer的名词复数 )

参考例句：

• Finance for education comes from taxpayers. 教育经费来自纳税人。
• She was declaiming against the waste of the taxpayers' money. 她慷慨陈词猛烈抨击对纳税人金钱的浪费。

18 irrelevant   

adj.不恰当的，无关系的，不相干的

参考例句：

• That is completely irrelevant to the subject under discussion.这跟讨论的主题完全不相关。
• A question about arithmetic is irrelevant in a music lesson.在音乐课上，一个数学的问题是风马牛不相及的。

19 statute   

n.成文法，法令，法规；章程，规则，条例

参考例句：

• Protection for the consumer is laid down by statute.保障消费者利益已在法令里作了规定。
• The next section will consider this environmental statute in detail.下一部分将详细论述环境法令的问题。

20 defrauds   

v.诈取，骗取( defraud的第三人称单数 )

参考例句：

• He often defrauds others of their money. 他经常骗别人的钱。 来自辞典例句

21 defense   

n.防御，保卫；[pl.]防务工事；辩护，答辩

参考例句：

• The accused has the right to defense.被告人有权获得辩护。
• The war has impacted the area with military and defense workers.战争使那个地区挤满了军队和防御工程人员。

22 punitive   

adj.惩罚的，刑罚的

参考例句：

• They took punitive measures against the whole gang.他们对整帮人采取惩罚性措施。
• The punitive tariff was imposed to discourage tire imports from China.该惩罚性关税的征收是用以限制中国轮胎进口的措施。

23 monetary   

adj.货币的，钱的；通货的；金融的；财政的

参考例句：

• The monetary system of some countries used to be based on gold.过去有些国家的货币制度是金本位制的。
• Education in the wilderness is not a matter of monetary means.荒凉地区的教育不是钱财问题。

24 interpretation   

n.解释，说明，描述；艺术处理

参考例句：

• His statement admits of one interpretation only.他的话只有一种解释。
• Analysis and interpretation is a very personal thing.分析与说明是个很主观的事情。

25 scoffs   

嘲笑，嘲弄( scoff的第三人称单数 )

参考例句：

• [ Scoffs ] Why should a young girl like that love an old fart like me? 为什么一个那样的年轻女孩应该喜欢我这样的老家伙？
• The noise of the moment scoffs at the music of the Eternal. 瞬刻的喧声，讥笑着永恒的音乐。

26 justification   

n.正当的理由；辩解的理由

参考例句：

• There's no justification for dividing the company into smaller units. 没有理由把公司划分成小单位。
• In the young there is a justification for this feeling. 在年轻人中有这种感觉是有理由的。